GLUCOMETER - An essential tool for diabetes control

Diabetes Mellitus is silent killer. It works continuously behind the patients eye. Sometimes the patient don’t know about the killer that is working inside him.  Occasionally he went  to a doctor for a different problem & during screening he was found to be diabetic. Patient becomes worried – all his favorite menus are going away from him. He going to lose the charms of life. Doctor has advised him to avoid sweets, fast foods, fatty foods. He need to take regular exercise. He is entering into a boring charmless life. But is that true? The truth is that you have to lose nothing but to be in a disciplined life. Whatever you do, you must keep your blood  glucose under control. That is your ultimate responsibility for you, for all the organs to work optimally. Secondly you must have adequate knowledge regarding diabetes, its complications, complications of treatment & what to do when complication arises.

DM may cause some problem silently & some other acutely. Uncontrolled diabetes gradually & slowly destroys your eyes(retinopathy), kidneys(nephropathy), nerve(neuropathy), heart(myocardial infarction), brain(stroke –cerebrovascular  diseases). It causes hypertension,  gastrointestinal problems, peripheral vascular diseases culminating into amputation of your limbs. Again it may cause some acute problem like diabetic ketoacidosis (in type-1) & hyperosmolar nonketotic coma(in type-2). Both this condition leads the patient to coma due to very high blood glucose level. Again as a result of treatment, patient may go into hypoglycemic coma  due to very low blood glucose. It sometimes damages the patients brain permanently if blood glucose is very low like 1.5 mmol/l or less. DM decreases patients immunity keeping him susceptible to life threatening infections.

All of these problems may be controlled if the patient can control his blood glucose level within the acceptable range. And this is possible by regular monitoring of blood glucose. You can measure your blood glucose in your home regularly in an almost painless procedure using a glucometer. Glucometer is blood glucose monitoring device which uses glucose oxidase or glucose dehydrogenase as reagent measure glucose in a colorimetric method. This gives you information whether you have normal or low or a high glucose level. Glucose level very according to age & feeding status.Normal ranges for blood glucose levels:

• Infant (40 – 90 mg/dl)

• Child < 2 years (60 – 100 mg/dl)

• Child > 2 years to Adult (70 – 105 mg/dl)

• Adult (70 – 105 mg/dl)

• Elderly patients (50 years/more) often have a slightly elevated blood glucose level, but should not normally exceed 126 mg/dl.

In fasting state, in an adult 60 to 100 mg/dl is accepted normal. Below 60mg/dl is considered as hypoglycemia & above 140mg/dl is considered as hyperglycemia. Glucose level above 200mg/dl in 3 consecutive fasting blood glucose level is considered as diabetic. Blood glucose rises after meal. 2 hours after meal it ranges between 140 to 200 mg/dl. Any level above 260 mg/dl is considered diabetic. These levels vary slightly from study to study though the variations are negligible.

The patient can titrate his medication or food intake according to glucose level like when he feels hypoglycemic he may take oral glucose like a glass of juice or  glucose gel to be applied in oral cavity  or may use a glucagon injection which many diabetic patients carry with them. A hypoglycemic patient may present following symptoms Normal or rapid respirations, Pale, moist skin, sweating, Dizziness, headache, Rapid pulse, Normal or low BP, Altered mental status, Anxious or combative, Seizure or fainting, Coma, Weakness simulating CVA. Most of time the patients can feel themselves & take some food early get relieved. Some unlucky patients may become unconscious & may need hospitalization.

On the other hand most of the time hyperglycemia remain unnoticed unless it very high causing diabetic coma. This unnoticed hyperglycemia  slowly poisons the patient.this can be prevented by regular checking using a glucometer.